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Washington Apple HealthMedicaid · Prior Auth · Prior Authorization · WA · Dentistry, Oral & Maxillofacial Surgery, Pediatrics +1 moreHigh impact

Frenectomy and Frenotomy Procedures Require Prior Authorization, Effective January 1, 2026

Act
by Dec 31, 2025
Effective date
Jan 1, 2026
Identified
Jul 14, 2026

Summary

Effective January 1, 2026, Apple Health (Medicaid) in Washington State now requires prior authorization for frenectomy and frenotomy procedures. Claims submitted without proper prior authorization will be denied. Providers must review billing guides for specific PA criteria and expedited PA eligibility.

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What to do

by Dec 31, 2025 · 6 steps
01Billing team must implement prior authorization requirement for frenectomy and frenotomy procedures in the billing system.
02Update all encounter forms and provider documentation templates to require PA before claim submission.
03Contact all providers to notify them of this requirement.
04Review the Washington HCA Dental-Related Services Program Billing Guide and Physician-Related Services/Health Care Professional Services Billing Guide (dated January 1, 2026) for specific PA criteria and expedited PA qualification requirements.
05Beginning January 1, 2026: Verify prior authorization approval before submitting any frenectomy or frenotomy claims to Apple Health (Medicaid).
06Do not submit claims for these procedures without documented PA.
If missed: Failure to obtain prior authorization will result in automatic claim denials per WAC 182-501-0050.

Original notice

Frenectomy and Frenotomy Procedures Require Prior Authorization, Effective January 1, 2026
content.govdelivery.com · Always check the source before changing claims.
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Related policy hubs

Washington Apple Health policiesWA policy changesDentistryOral & Maxillofacial SurgeryPediatricsENT (Ear, Nose & Throat)

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